Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 4901 | MA |
N | 103G00000X | Clinical Psychologist | 022114 | NY |
N | 103TC0700X | Clinical Psychologist | 022114 | NY |
Y | 103TC1900X | Counseling Psychologist | 022114 | NY |
NPI | 1043309537 |
---|---|
Provider Name | Dr. John Michael Michna |
First Address | Bayside, NY 11360-2323 |
Second Address | Bayside, NY 11360-2323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 26/09/2018 |